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Canada Anxieties over COVID-19 and possible PPE shortages prompting some health care workers to draft wills

10:10  07 april  2020
10:10  07 april  2020 Source:   cbc.ca

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Paramedics wearing personal protective equipment unload patients at the Hôpital de Verdun's emergency department last week. Front-line workers dealing directly with patients are growing increasingly anxious that a surge in COVID-19 cases in the coming days and weeks will lead to a shortage of protective equipment. © CBC/Radio-Canada Paramedics wearing personal protective equipment unload patients at the Hôpital de Verdun's emergency department last week. Front-line workers dealing directly with patients are growing increasingly anxious that a surge in COVID-19 cases in the coming days and weeks will lead to a shortage of protective equipment.

She had been putting it off for a while, but after enlisting to be on the front lines in the battle against coronavirus, Michelle Cohen says now it's time to get her will done.

"That's a discussion I had just this week with my husband — and it's something we've all been thinking about," she said in an interview with CBC News. "There's been a lot of discussion about that with colleagues."

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Based in Brighton, Ont., Cohen is a family physician and mother of three. She works at a local family clinic and hasn't yet been called for hospital duty but is on a list at Trenton Memorial Hospital of those who will be drafted as needed.

She and the more than 43,000 other members of the Ontario Medical Association received an email March 24 with tips and resources for updating wills or writing a first will. The association said it compiled the resources in response to queries from its members, who include physicians, medical students and retired physicians.

Cohen says there's an ominous feeling among many of her colleagues already treating COVID-19 patients that they may run out of the equipment that protects them from contracting the novel coronavirus that causes COVID-19, such as masks.

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"I'm pretty scared for myself and for my colleagues," she said.

Canada has close to 16,000 cases of COVID-19 and at least 340 related deaths so far, and those numbers are growing every day.

1 mask per shift

On Monday, Ontario Premier Doug Ford said that delays in global shipments and restrictions at the U.S. border have "severely strained Ontario's inventory" of masks and left Canada's most populous province with "roughly a one-week supply" of critical personal protective equipment.

Cohen says she's hearing concerns about protective equipment from colleagues not just in Ontario but across the country. 

"That they don't have enough at their hospital; that they're being told to ration; that they're worried about running out of protection or having to reuse dirty equipment."

According to memos obtained by CBC News, some major Toronto hospitals are already rationing surgical masks — in some cases even urging nurses and other front-line staff to use just one mask for an entire shift. Similar conserving of PPE is being reported at hospitals in B.C. 

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At Vancouver Coastal Health, new guidelines issued just over a week ago instruct all staff who have direct contact with patients to wear a mask at the beginning of their shift but not to change that mask between patients — which is what is normally recommended to preserve the integrity of the mask and ensure full protection.

"Change your mask if it is visibly soiled, damp, damaged for safe use and immediately perform hand hygiene," the healthy authority's guidelines say.

Medical staff should change their masks during breaks and when leaving the patient care area, the authority said.

A recent memo sent to Hamilton Health Sciences in Ontario with similar guidelines set off alarm bells, according to Doris Grinspun, head of the Registered Nurses' Association of Ontario (RNAO). 

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She says she alerted the provincial health minister about directives suggesting emergency department staff should be using surgical masks until they are "grossly soiled or wet," with even N95 masks only being replaced when meeting that criteria.

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Grinspun says she was livid when she heard about the memo from her members.

"Would you send a fireman without a hose and tell them to use their hands?" she said. "That is inviting people to get sick, health workers and patients. Nine million masks a week is what we need so the staff can focus on providing care, without fearing they will get the virus themselves, or that they're giving the virus to colleagues and patients." 

Grinspun says that already, several nurses she knows are either in isolation or are ill with COVID-19 at home.

"I have one colleague in ICU, because she didn't have a proper mask."

In Quebec, a nurse who spoke to CBC on the condition of anonymity said Montreal General Hospital ran out of certain sizes of N95 masks last month, and at one point, it had no protective face shields left. To protect their eyes, nurses on her unit wore goggles instead of face shields, the nurse said.

a person wearing a hat: A nurse at Montreal General Hospital told CBC News that her unit ran out of face shields, like the one Burnaby, B.C., physician Lindsay McCaffrey is wearing in this photo, and had to resort to goggles. The hospital said it was currently not short of protective equipment. © Rafferty Baker/CBC A nurse at Montreal General Hospital told CBC News that her unit ran out of face shields, like the one Burnaby, B.C., physician Lindsay McCaffrey is wearing in this photo, and had to resort to goggles. The hospital said it was currently not short of protective equipment.

Annie-Claire Fournier, a spokesperson for the McGill University Health Centre, which runs the hospital, told CBC in an email that there is no mask shortage at the hospital. 

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"This is a priority for us, and the current inventory meets our needs and is monitored on a daily basis," she said.

Hospitals across the country have been accepting donations of protective equipment, and some have reached out to manufacturers in their communities to see if they can meet the demand. 

Sault Area Hospital in Northern Ontario did a call-out in March, saying "all critical supplies are in short supply, and we are investigating all innovative opportunities to secure additional equipment." 

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Attached to the statement was an approved pattern for sewing masks, so members of the community could start making masks and dropping them off at the hospital's main entrance. 

Olympic gold-medallist and medical student Hayley Wickenheiser sent out a message on Twitter requesting masks, gloves and gowns for frontline workers in Toronto. The quantities listed by the Olympian included 1,350 N95 masks and 13,500 surgical masks.

"The federal government, as I say, was a little slow," said OMA president Dr. Sohail Gandhi.

He says he regularly hears concerns from physicians about PPE, and more recently, it has been resulting in the closures of some outpatient clinics. 

"The outpatient clinics keep people from going to the hospital, and we need to figure out how to distribute the supplies in a fair and equitable manner so the hospitals get what they need, and outpatient clinics get what they need," said Gandhi.

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On Friday, Prime Minister Justin Trudeau said millions of surgical masks were on their way to Canada from China on a chartered cargo flight.

"We are also working with provinces to transport their medical supplies when possible," said Trudeau. 

WATCH | Prime Minister Justin Trudeau reacts to clampdown on mask exports:

When will they see equipment?

Meanwhile, the country is preparing for more made-in-Canada solutions to manufacture more PPE, with Ottawa signing deals with three Canadian companies to make critical equipment, such as ventilators, masks and test kits. 

So far, there's no clear timeline indicating how soon any of these supplies will reach hospitals.

"It's not often that we think about our own safety," Cohen said. "We do tend to kind of have this culture of self-sacrifice … We feel like the job is so much more important than our physical needs so much of the time." 

In the meantime, she says she's waiting for information on when medical supplies will reach her colleagues across the country.

"If we're being asked to do something that's not safe for us, our families, our community and our patients, I think people are going to start to wonder whether or not this is the right thing to do ... No one signed up to be on a suicide mission."

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Ontario reports 411 new coronavirus cases, including 31 deaths as total cases top 6,600 .
Health officials in Ontario reported a continued increase in cases of COVID-19 Saturday. The death toll has now risen to 253.The death toll has risen to 253.

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